Author + information
- S1936879815021548-ad115707025aa086e81d7ccc78f7e9e9Manuel A. Gonzalez,
- S1936879815021548-d77e963e4d2c3d66196d55cc87b0c1feEnrique Filgueiras,
- S1936879815021548-9bdb2cce82800c35ceb0f539c0a48e18Glenn Barquet,
- S1936879815021548-2902279c3d070cd2a14838cc554333efFrancis Crespo,
- S1936879815021548-5925c66eb1891e62150adc2a68828f80Gibert Gonzalez,
- S1936879815021548-17aec5ae4e56bd893862895ce28c3c83Omar Meliz,
- S1936879815021548-8386e20df1a95dfe5eb5d28adbabf4bbSuleidy Castillo,
- S1936879815021548-8aa2c4f4db88bac77f283a4768ccd5c0Guillermo Gonzalez,
- S1936879815021548-3164a6d0757d11c4000f9b5de59979ddSara Laria,
- S1936879815021548-70ddf0da367899b92d6cf32a220fa119Jose L. Collazo,
- S1936879815021548-22fdc0db2291bdead6e1d1241656bf2dJose Pinero and
- S1936879815021548-3631c1b40b63efe2cc13e78b26b735fbLisyannet Talavera
Critical limb ischemia (CLI) is a devastating manifestation of peripheral arterial disease that frequently involves severe below-the-knee arterial stenosis. Drug-eluting balloon expandable stents (DES) have been reported to be useful in inpatient treatment. However, it is unknown whether using outpatient DES is safe and effective for ambulatory CLI revascularization.
We studied the safety and efficacy of using DES in outpatient proximal below-the-knee tibial arterial stenosis. A total of 75 consecutive CLI patients underwent limb salvage outpatient endovascular intervention using DES in the proximal tibial arteries. Sixty-four patients (69 limbs) complete follow-up. The primary endpoint was binary restenosis by quantitative angiography and/or Doppler ultrasound at one year. The secondary outcomes were amputation prevention, wound healing, symptom improvement, and procedure complications.
The mean patient age was 75±10 years. There were 69 DES implanted (62 were Medtronic Resolute 0.014” DES and 7 were Boston Scientific ION 0.014” DES). The mean follow-up period was 15±3.8 months. The number of stents per patient was 1.08±0.9, mean length of 36±1.3 mm, and mean diameter 3.4±0.3mm. Diabetes Mellitus was found in 90.6% of the patients. All segments were successfully treated with no significant residual stenosis. Angiography follow-up was available in 27 (39.1%) patients with cumulative binary restenosis of 14.8% and there were no stents crushed or deformed. The rest of the patients (60.9%) had Doppler ultrasound follow-up with cumulative binary restenosis of 7.1%. The overall binary restenosis was 10.1%. There were no procedural-related deaths, heart attacks, strokes, or hospitalizations. All patients were discharged home within 6 hours after the procedure. During the follow-up, there was no limb amputation reported and all angiosome-related ulcers were healed.
Outpatient use of DES for proximal tibial artery stenosis is a safe and effective strategy in CLI revascularization. The rate of binary restenosis was similar as reported in the literature for inpatient procedures. There were no procedural related complications, no amputations, and all wounds healed during follow-up. However, there is a need to improve the restenosis rate and new modalities need to examined.